Risultati per: Nota 87

Stroke, Volume 55, Issue Suppl_1, Page A87-A87, February 1, 2024. Introduction:Early identification of intracranial atherosclerotic disease (ICAD) underlying large vessel occlusion strokes (LVOS) may allow for mechanical thrombectomy (MT) optimization. We sought to create a pre-procedural scoring system to predict ICAD.Methods:Retrospective analysis of prospectively collected MT databases from 2 comprehensive stroke centers (derivation and validation) including patients with anterior circulation LVOS. ICAD cases were matched for age / sex (1:1) to non-ICAD controls and stepwise logistic regression utilized for various clinical and radiological (NCCT, CTA and CTP) variables. Calibration slope / intercept as well as the area under curve (auROC) were assessed.Results:Of 2870 MTs within the study period, 174 anterior circulation ICAD (6.6%) were matched with 174 controls (n=348) in the derivation cohort. Multivariable analysis β coefficients lead to a 20 point-scale: absence of AF (5), vascular risk factor burden (1 for each: hypertension, diabetes, smoking, hyperlipidemia), CTA multifocal ICAD (3), absence of cortical infarcts (3), presence of borderzone infarct (3), calcium at the siphon (2). The validation cohort comprised 75 ICAD patients (6.9% of 1359 MTs) and 75 controls. AuROC for the derivation cohort was 0.88(0.84-0.91) while for the validation cohort 0.82(0.73-0.89). Calibration slope and intercept showed a good fit for the development cohort although with overestimated risk for the validation cohort. After intercept adjustment, the overestimation was corrected (intercept 0; 95%CI -0.5-0.5 / slope 0.8 95%CI 0.5-1.1). In the full cohort (n=498), ≥ 11 points showed the best performance for distinguishing ICAD from non-ICAD patients, with a sensitivity 0.71 (0.65-0.78) and specificity 0.82 (0.77-0.87), a positive likelihood ratio of 3.92 (2.92, 5.28) and a negative LR of 0.35 (0.28, 0.44). Scores ≥ 12 showed 90% specificity, although sensitivity of 63% (55%-69%).Conclusion:We developed a predictive scoring system for pre-procedural diagnosis of ICAD LVOS with satisfactory discrimination and calibration based on clinical and non-invasive radiological data.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

A partire dal 27 giugno 2023 è disponibile un aggiornamento dei documenti allegati alla Nota 100 (schede di prescrizione ed elenco dei farmaci)

L’Agenzia Italiana del Farmaco ha aggiornato la Nota 96 (determina AIFA n. 48/2023 pubblicata nella Gazzetta Ufficiale n. 43 del 20 febbraio 2023) sui criteri di appropriatezza prescrittiva della supplementazione con vitamina D e suoi analoghi (colecalciferolo, calcifediolo) per la prevenzione e il trattamento degli stati di carenza nell’adulto

Stroke, Volume 54, Issue Suppl_1, Page A87-A87, February 1, 2023. Background:Area deprivation is one of the leading social determinants of health and is associated with lower access to clinical care. We hypothesize that undiagnosed hypertension is more prevalent in highly deprived areas as well as in people from black race and that undiagnosed hypertension is associated with a higher risk of incident stroke.Methods:We conducted an observational study analyzing participants from the All of Us study (AoU). We identified people who meet the criteria for hypertension based on blood pressure measurements at the time of enrollment but were not known to have the condition according to EHR or survey data. We evaluated area deprivation using the Deprivation Index (DI), an aggregate variable derived from six metrics of the American Community Survey. We used multivariable logistic regression to test for interaction between tertiles of DI and race in a model predicting undiagnosed hypertension adjusting for age, sex, income, and education.Results:Out of 372,397 participants enrolled in AoU, 269,063 had data for area deprivation and blood pressure, including 6,690 (2.5%) who sustained a stroke. Compared to low area deprivation, intermediate and high deprivation were associated with 3.4% (OR 1.034, 95%CI 1.00-1.07) and 17.4% (OR 1.174, 95%CI 1.14-1.21) higher risk of undiagnosed hypertension (test-for-trend p

L’introduzione della Nota 100 da parte dell’Agenzia italiana del farmaco ha riconfigurato le modalità di prescrizione di alcune classi di farmaci per il trattamento del diabete mellito di tipo 2, che possono essere prescritti anche dal medico di famiglia

Stroke, Volume 53, Issue Suppl_1, Page A87-A87, February 1, 2022. Introduction:Chronic kidney disease (CKD) is increasingly recognized as a risk factor of cerebral microvascular disease, but its association with common neuropathologic changes is not well understood. We investigated the relationship between CKD and development of cerebral microhemorrhages (CMH) in a mouse model of aging. We also examined the effect of CKD on endothelial cell function in anin vitroblood-brain barrier (BBB) model.Methods:CKD was produced in aged C57BL/6J mice using an adenine-induced tubulointerstitial nephritis model. We performed standard histology using Prussian blue staining to examine CMH formation. Correlations between CMH burden and serum creatinine levels were assessed. In cell culture studies, human brain microvascular endothelial cells (ihBMECs) derived from induced pluripotent stem cell line IMR90-4 were treated with serum from healthy or CKD patient donors for up to 3 days. Transendothelial electrical resistance (TEER) and tracer (sodium fluorescein) permeability across the ihBMEC monolayer were measured to assess the integrity of thein vitroBBB.Results:CKD induction in aged C57BL/6J mice caused a significant increase in both serum creatinine level (0.09±0.01 mg/dL to 0.43±0.03 mg/dL, p

Risultati positivi dalla Nota che amplia agli mmg la prescrizione di anticoagulanti orali diretti per i soli pazienti con fibrillazione atriale non valvolare. Un percorso che coinvolge sempre di più il territorio e la medicina generale nella presa in carico di pazienti cronici.